Nancy Snyderman isn't helping. At least, she wasn't helping yesterday.
Don't get me wrong. I like the fact that NBC's Chief Medical Editor Dr. Nancy Snyderman is a staunch defender of vaccination. She's one of the rare talking head doctors on TV who pulls no punches when going after the anti-vaccine movement, so much so that the big macher of the anti-vaccine movement and head of the anti-vaccine crank blog Age of Autism J.B. Handley has referred to her as a "NBC's pharma-whore in residence." Let's just put it this way: Anyone whom J.B. detests and labels with a term like that can't be all bad, right?
Unfortunately, in her zeal, Dr. Snyderman doesn't always get her ducks all in a row when she's on a roll, which irritates me to no end. For example, she was on The Today Show yesterday morning to discuss the pertussis outbreak in California:
Visit msnbc.com for breaking news, world news, and news about the economy
In it, Dr. Snyderman is very passionate and points out that there are large numbers of unvaccinated children in many of the areas where pertussis outbreaks have occurred. She then makes this claim when asked if she thinks the pertussis outbreaks will spread to other states:
I have no doubt that it's going to. It peaked in California. Last year in Minnesota and in Philadelphia we know children died of measles.
No, actually, we don't. There was not a single measles-related death in the U.S. last year--fortunately. It's not for the lack of anti-vaccine advocates trying to drive down vaccination rates and destroy herd immunity, but over the last couple of years we have been fortunate. Measles kills hundreds of thousands of children a year in Third World countries. In countries fortunate enough to have the advantages of good sanitation, nutrition, and vaccines, deaths from measles remain fortunately quite rare. For now. If the anti-vaccine movement has its way, we could join the U.K. with a resurgence of measles to endemic levels a decade after having been declared as under control, thanks to vaccination. Such is the damage that Andrew Wakefield, with the fawning and eager help of British tabloids, wrought. Now Jenny McCarthy appears to be trying to duplicate Wakefield's feat here across the pond.
My guess is, as speculated at Autism News Beat, that Dr. Snyderman was in part referring to the haemophilus influenzae b (Hib) outbreak that have occurred in Minnesota, although the Minnesota outbreak occurred in 2008, not last year. One child did die in November 2008. Two children did die in Philadelphia last year in a pertussis outbreak. In any case, as much as I detest the anti-vaccine movement and view it as a profound threat to public health I try to be careful not to leap to premature or erroneous conclusions blaming them for outbreaks. Doing so undermines the credibility of the pro-vaccine argument. Worse, it provides an opening for anti-vaccine loons to focus like a laser on obvious factual errors like the one Dr. Snyderman made and ignore her broader point, which remains valid, namely that vaccines do not cause autism and are safe and effective. The propagandists over at Age of Autism may be advocates of pseudoscience and dead wrong about medicine, but they aren't stupid. They know debating tricks, and they know how to jump on an opponent's errors. They can distort and cherry pick studies all they want. We on the science-based side of things don't have that luxury and wouldn't want it even if we did. We have to deal with all the messy nuances and try to boil them all down, as Dr. Joe Albietz did in discussing the pertussis outbreak.
Of course, one point that needs to be hammered home over and over again is a point made by Sullivan over at LBRB and that's that the various "alternative" vaccine schedules championed by various anti-vaccine advocates endanger children and the pertussis outbreak represents a "teachable moment" to show how and why. One of the favorite "alternative schedules" touted by Generation Rescue was created by Dr. Donald Miller (a crank we've heard about before in the context of his extreme distrust of peer review). The interesting thing about this schedule is that he recommends not vaccinating at all before age 18 to 24 months, which is far too late for pertussis, which is most lethal to babies under that age. The GR schedule also calls for a single pertussis vaccine after age two. As Sullivan points out, no such vaccine exists; pertussis requires multiple boosters to achieve immunity.
It's a general rule in skepticism and science that pseudoscientists have the advantage. They can distort; they can cherry pick data; they can Gish gallop. Countering these tactics takes a lot of energy and care. On the skeptical side, we have very little room for error because even one error, even a relatively minor one, can provide advocates of pseudoscience a club with which to pummel us, or, at the very least, a hand puppet with which to distract the audience form our main points. I like that Dr. Snyderman is willing to take on the anti-vaccine movement. I just wish she were more careful to make sure that she has her facts in order. Unfortunately, this isn't the first time she's screwed up like this. I'm just an itty bitty blogger (well, in comparison to being seen by millions of people the reach of this little blog is quite paltry), and even I can't get away with it.
Dr. Snyderman. Please be more careful! I'd hate to see a post on AoA in the morning attacking you for this slip, but it wouldn't surprise me in the least if I wake up to just such a post.
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Slightly off topic but I have recently learned one of my favorite shows (though not one I always agree with) penn and tellers "bullshit" will be doing an episode on vaccines. So you may want to keep a lookout for that. Hopefully they get the facts right and don't make a mistake similar to Dr. Snydermans, as they do have a pentiont for hyperbole on tht show.
Nothing up there yet. Even more surprising, still no article about Boyd Haley's withdrawing OSR#1 from market.
@Todd W.: I'm shocked, shocked I tell you! .
AOA hasn't posted on the withdrawal of OSR yet? Goodness. Where am I going to get my autism news from now if they can't stay current?
/snark
But I can readily believe that they will post something about Dr Snyderman's error. After all, the more they can point to the errors by the "medical establishment", the less visible their lies are.
I ran up against this during the flu pandemic of 2009. Many people, some in power, many on the street, claimed that it wasn't a pandemic since so few people died from it.
Well, yes and no. The number of cases reported is only a fraction of the true number of cases out there. (Whether the fraction is very small or large depends on the disease.) That is, of all the people who are exposed, only some are infected. Of all those infected, only some get sick enough to seek medical care. Of all those who seek medical care, only some get tested. And, of all those tested positive for a disease or condition, only some get reported.
In Public Health, we can only state with certainty the number of reported cases, and then only estimate the true number of cases. (I have several projects going on to try to deal with this, but that's for some other time.)
I'd like to give Dr. Snyderman the benefit of the doubt and speculate that perhaps one of her colleagues described to her the story of a fatal case of a vaccine-preventable disease (measles or pertussis) which was either not lab-confirmed or not reported... Or not reportable in their jurisdiction.
And I just know that Augustine is going to write that I'm taking the Doc's anecdotal data over anti-vaxers' anecdotal data... We'll deal with that later on this morning, when he wakes up over on the West Coast.
Dr. Nancy's overall message is positive, and the AoA Drones may not want to publicize it. However, since the Drones have a penchant for cherry picking quotes and misquoting, they just may use her comments in some nefarious manner. They are unpredictable.
As for their lack of reporting of the OSR withdrawal, perhaps they have a ve$ted interest in maintaining sales through the bitter end? Just $peculating.
Oh, and it was Yogi Berra who said, "Daja vu all over again."
There were measles deaths in Philadelphia, but certainly not last year. In 1991, 5 children died from measles; their parents were members of a fundamentalist anti-vaccine church. Paul Offit, based in Philadelphia, often refers to these totally preventable deaths.
Here's a link to a NY Times article about those deaths.
http://nyti.ms/axalcK
"Well, yes and no. The number of cases reported is only a fraction of the true number of cases out there."
And therefore the true case fatality is exaggerated.
"Dr. Nancy's overall message is positive."
Oxymoron. Skeptics by nature are pessimists.
@Augustine
Good morning, counselor. And I call you "counselor" not because I think you're an attorney, but because you are this blog's advocatus diaboli (which is also the name of a rather spicy gucamole dish).
I hope you slept well.
So, as it turns out, no, the case fatality is not exaggerated. This is Epidemiology 101, so try to stay with me here, 'Gus... You know how I wrote about the number of cases picked up by surveillance are an underestimate of the real number of cases? Guess what? Works the same way for deaths.
Mind-blowing, I know. (Kind of like your deconstructions are mind-numbing.)
Sticking with the H1N1 pandemic, the true number of deaths probably rivaled a "very bad" flu season. It's just that we lacked the technology to test for it (no PCR materials) AND flu deaths in adults is not a reportable condition in many States. So, no reports = no cases = no deaths = low case fatalities (on paper).
Alright, I've pretty much filled my quota for the week of dealing with the devilish avocado... He's y'all's problem now.
augustine said:
Skeptics by nature are pessimists.
I beg to differ. I am very much a skeptic but rarely a pessimist. Skepticism only expresses a desire to base conclusions on reproducible evidence. In no way do I always expect that evidence to confirm the worst outcomes.
Hib killed a child in Minnesota in Jan, 2009.
http://tinyurl.com/cjufeu
The Philadelphia Inquirer reports two Hib deaths in 2009, and a suspected third.
http://tinyurl.com/csm48n
I don't think the people at AoA can be bothered to keep up with every little lie that comes out of the pharma whores' mouths. It would be great if all the scientists/researchers did care to such a great degree about being credible but they seem not to. For ex. why would you compare a vaccine like Gardasil to a placebo containing aluminum and call it a true placebo? People see the disingenuousness in things like that. Also, although you criticize the Pittsburgh research done on primates, shouldn't that kind of vaccine research have really been done pre-licensure before being given to children en masse? Also, the everyday lies like Wakefield having sourced the children in his case series by lawyers to sue vaccine manufacturers. They were just kids referred by their physicians based on their clinical symptoms.
Check out the pics on Brian Deer's website. They say a picture tells a thousand words. I guess in Brian's case it's PICTURES. The guy is clearly crazy in a self-obsessed kind of way. The pictures don't lie.
Sticking with the H1N1 pandemic, the true number of deaths probably rivaled a "very bad" flu season. It's just that we lacked the technology to test for it (no PCR materials) AND flu deaths in adults is not a reportable condition in many States. So, no reports = no cases = no deaths = low case fatalities (on paper).
-----------------------------------------------------
I know. I know. "probably", "Lacked the technology", "not reportable"
Just a big systematic guessing game with lots of overestimating and underestimating.
The Ny Times article cited @6 says measles kills 1 out of 300. HMMM.
"Yeah. 220... 221, whatever it takes."
Stay classy, Jen. Stay classy. Opening arguments like that can only lead to a proper discussion of your grievances and a peaceful resolution.
Also, they may be "whores", but at least they're not TROLLS.
Why bother? They've got enough of their own.
"Also, although you criticize the Pittsburgh research done on primates, shouldn't that kind of vaccine research have really been done pre-licensure before being given to children en masse?"
Lower case jen, the readers here are right to criticize Hewitson's research. It's garbage.
Ironically, in addition to it being garbage, that "research" was heavily funded with Johnson & Johnson money; where's your outrage about that? Don't you think autism research be completely divorced from Pharma influence, jen?
Poor monkeys, tortured and sacrificed for no good reason other than to continue promoting the belief that vaccines cause autism.
Orac, calm her down, help her. Okay?
Looks like jen was reading a recent article at AoA discussing about how Brian Deer is a narcissist. Ahem, jen? Do you ever have your own thoughts?
Because you want to find out the effect of the vaccine, not test the effects of other things already known to be safe.
Only those who do not understand how it works.
Indeed, careful safety testing should have been done first. And you know what? It WAS. And demonstrated safety.
And yet, the facts say otherwise. Wankerfield was the one who lied - and was caught at it.
Scott
Placebo: dummy medicine containing no active ingredients; an inert treatment
Inert: A substance that does not react chemically
------------------------
The aluminum salts used as adjuvants have been associated with erythema, subcutaneous nodules and contact hypersensitivity.
Therefore the concoction containing Al is only a placebo in your imagination
@jen and Sid
Well, they didn't call it a "true placebo". They called it a placebo. And, in fact, they did use a saline placebo in addition to alum placebos. Study 018 notes that a saline placebo was used, as seen in this 2006 clinical review for Gardasil (PDF link). Just search for "saline" and you will find where it was used and how it compared. There is also this 2008 clinical review, which also mentions a "true saline placebo".
So, you may want to check your facts before spouting nonsense.
Yes, quite classy jen. By that metric (and to present it at your level), your fearless leaders and co-commentors would also be such and more, like pimps.
Because it is a true placebo, dumbass. The absolute effects of the vaccine are being quantified, that means that the placebo is all vaccine constituents minus the antigens. They are not examining the effects of aluminium; that is a completely different set of parameters.
It is done and better than that crap that Hewitson is flinging around. And yet, she found abnormal brain development in the unvaccinated monkeys and normal brain development in vaccinated monkeys. There is your evidence by one of your 'own' scientists. Eat it.
Nope, most were referred by Barr, the solicitor involved with the GSK suit or contacted Wakers directly. Where is your evidence that they were all physician-referred? Try thinking for yourself a bit jen, you really sound like a pathetic mouthpiece for a group of fools.
Oh waaaaahhh, Brian Deer has OMH! Pictures of himself on his website. You call that crazy obsessed? What does that speak of Jake Crosby to have dedicated an entire post about it? What a sad lot you are.
Actually, it's a placebo in the mind of anyone who understands the concept (which is not so simplistic).
augustine, jen and Sid before the comments hit 20, add Jay and Jake by 25 and the collection is complete.
I doubt AoA will go off on that tangent, nitpicking that the baby died 2 months earlier from a different vaccine preventable disease isn't really distracting enough from the "babies die of vaccine preventable diseases if you don't vaccinate" message.
"Check out the pics on Brian Deer's website. They say a picture tells a thousand words. I guess in Brian's case it's PICTURES*
Actually, in Brian Deer's case it's a ton of excellent journalism that, more than any other, led to the unmasking of sleazy pseudoscience that posed a substantial hazard to public health. Try reading the articles on the website.
Speaking of pitiful narcissism, there's that bit of comedy gold on the AoA website detailing how you can win lunch with Andrew Wakefield.
Now there's a powerhouse celebrity experience.
*Jake Crosby was really scraping the bottom of the barrel with this revelation.
Dr. Snyderman is extremely knowledgable and a great advocate for kids. It is not so easy to do live interviews. When you write or blog, you can go back and check, correct, revise. When you are live, sometimes you say something in such a way that you wish you could go back and revise, but you can't. I agree that Dr. Snyderman was probably referring to HIB deaths and not measles, but that should not detract in any way from the point she was making about vaccine preventatable disesases having the potential to cause death.
I checked out Mr. Deer's website. I saw a lot of pictures of a disheveled-looking guy with heavy eyelids. Yes, the pics clearly show a crazy, self-obsessed guy.
Wait a minute, those are pictures of Wakefield.
Yep, the pictures don't lie.
Jake Crosby specializes in scraping the bottom of the barrel.
@Dumbass
Because it is a true placebo, dumbass. The absolute effects of the vaccine are being quantified, that means that the placebo is all vaccine constituents minus the antigens.
----------------------------------
So you're saying that
sulfate, yeast protein, sodium chloride, L-histidine, polysorbate 80, sodium borate [all in Gardasil]
are antigens or are you saying that they to were in the "placebo"
At a guess, because aluminum is an adjuvant in Gardasil. A true placebo is one in which the active ingredient has been removed. Usually there is an accompanying study in which a reference placebo is used, such as a saline solution for injections. This allows for a safety evaluation of both the vaccine and the accompanying adjuvant.
(yes, I am aware that jen is trolling, but I thought this point was worth explaining for the lurkers)
@Alison Singer
I'd agree with you if it weren't for the fact that this is not the first time Dr. Snyderman has done this. She has a disturbing tendency to make such mistakes. I love her enthusiasm about defending vaccines, but when you're that enthusiastic you need to be particularly careful to be accurate because you're making yourself a target and don't want to give your opponents ammunition to use against you.
I learned this the hard way as a blogger. It's also why I sometimes apply a bit of tough love to new defenders of vaccines (like Phil Plait) when they make newbie mistakes.
@Alison
Dr. Snyderman is extremely knowledgable
-----------------------------
So why does she make the same "mistake" over and over and over again. On Morning Joe on Feb 15th she said "right now we have children dying in the US from measles and mumps" and Orac has a link to even more of her "mistakes"? Her willful ignorance will do your cause more harm than good in the long run so please, keep defending her.
PS
Must be that pressure of being on TV. But wait didn't she have her own TV show?
Alison,
The sad thing is that there's no room for error when it comes to the anti-vaxers. Anything that's a mistake - or even perceived to be one - is jumped on by them as either bias, cluelessness, or nefariousness.
You can bet that even if Nancy Snyderman retracted her statement now, the meme that she made this incorrect assertion about measles deaths in Philadelphia is going to be all over the troll-net in a matter of days. And then folks like us will have to spend time refuting it again.
Of course this is all unfair, because anti-vaxers make mistakes big enough you can drive a truck through them. But this is the world we live in.
And for those bickering about alum not being a placebo, here's how MedlinePlus defines it, emphasis added:
@sid offit #28: OH NOES! Not SODIUM CHLORIDE in my vaccines! !!!!eleventyone!!!!!!!!!!!!
Grow up, sid. You probably could find all those ingredients in the food you eat every day, too, in much larger amounts than in the gardisil vaccine. And yes, I do know the difference between oral intake and intramuscular injection. I also know the fact that the dose makes the poison.
But this does give me the chance to point out again that gardisil vaccination has been found to decrease the number of pre-cancerous cervical lesions in women in Australia, so it will probably prevent cervical cancer down the road.
It is always a good idea when comparing two populations to vary only one parameter at a time.
Here is an example even jen and Sid can understand:
You like to cook eggs in butter in a non-stick pan. One day, you cook eggs in margarine in a regular pan, and they turn out crappy. Was it the margarine or the pan that screwed it up?
@Rob
[channel jen]The eggs were obviously to blame! It doesn't matter if you use butter, margarine, non-stick or regular pans. The eggs are teh poizonz!!![/channel jen]
Todd W.
Damn! I knew I shouldn't have boiled a few eggs before heading to sleep last night.
Trisket: "Australia, so it will probably prevent cervical cancer down the road."
New promotion for Gardasil.
"Gardasil. Probably a cancer vaccine."
@triskelethecat
You're missing the point. I'm not saying SODIUM CHLORIDE is dangerous - yes the dose makes the poison. It's just that Science Mom said it's either in the "placebo" or it's an antigen but clearly SODIUM CHLORIDE is neither an antigen nor is it in the "placebo"
Sid - do you know what's in saline? Hint - it's that horrible sodium chloride.
"I guess in Brian's case it's PICTURES"
Oh...My...God! He didn't put actual pictures of himself on his website did he?!?
Had he done this 10years ago and allowed other to make their own pages with their own pictures and stories and called it "FaceBook", he probably would not have had the time or inclination to worry about the Wakefield saga.
Hehe Sullivan. They keep writing stupid posts like that over at AoA. They really do not seem to take a few minutes to think about it, see what it implies and whether or not it is really meaningful. I wonder if Jake has facebook and photos of himself there. How vain that would be.
The Phase II & III trials of Gardasil used the alum-containing placebo control described in http://www.ncbi.nlm.nih.gov/pubmed/15863374
(Well, at least the publications with which I am familiar cite this publication directly.)
The relevant passage in the methods:
Thus, the only reported difference in ingredients between the test and control vaccines is the presence of purified VLPs. It appears to be a perfectly valid placebo control.
I was a little suprised to see no mention of of maybe some simple NaCl to make the solutions isotonic...it's usually uncomfortable to be given something hyper- or hypotonic.
As for the current ingredients of Gardasil:
I've yet to see a credible argument as to why these extra ingredients, likely used as buffering and stabilizing agents, should reduce the safety or efficacy of the vaccine (other than for those with actual allergies to any of these components).
@34
Uhhhh... You are forgetting that we inject sodium chloride solutions directly into our veins at hospitals all the time.
There is no mention of NaCl not being in the placebo, see Scientizzle's post and link above. In order to keep the placebo and vaccine indistinguishable in appearance and 'feel', there is no reason not to have NaCl.
You and yours are really beating a dead horse about the use of this type of placebo and its constituents. They weren't testing the effects of AAHS after all.
Scientizzle,
How much of the daily recommended intake of sodium does 9.56 mg NaCl represent? Is it possible that this bolus of salt contributes to hypertension in the recipients of vaccines? Maybe there a correlation between hypertension and autism.
Just thinkin'.
Wonder if jen has caught this aspect.
Rob, the 9.56mg of NaCl per dose pales in comparison to...um...just about every serving of food.
Then again, I expect the unhinged counter-argument would be something along the lines of 'but we dont inject celery directly into teh bloodstreamz of teh helpless babbies!'
More info, extending my comment above: here is the Gardasil patent, which provides an explanation for the use of these other components as buffers and stabilizers.
@Adam_Y: no, I didn't forget about normal saline IVs. Or D5W IVs (oh noes! injecting glucose into the blood!!!!) Or, as we used in some babies, D10W (EVEN MORE glucose) and also hyperal IVs (sodium! chloride! potassium! calcium! amino acids....ACIDS, I say!!!) Won't someone think of the babbies???
I just figured poor Sid was confused enough, and to give him facts like that would just make things worse. He can't handle medical facts.
@D Lurker
Good point on the Sodium chloride and saline
But since sulfate, yeast protein, L-histidine, polysorbate 80, and sodium borate are not in the saline solution or "placebo" my point is still valid.
Well, Sid, tell me what all those things are and what detrimental effects they have on the body. Citations please.
It's only valid if a.) other vaccine constituents were not present and you have yet to demonstrate that or b.) The constituents in the placebo altered the absolute effects of the vaccine.
Sid, your point does not appear valid. I just provided evidence that the only thing reported (in at least one phase II and two phase III trials that I perused) to be different between the test vaccine and the control vaccine is the presence or absence of purified HPV VLPs.
Is your proposition that the safety or efficacy of the vaccine is altered by sodium chloride, L-histidine, polysorbate 80, sodium borate, and/or yeast protein?
I never said there were any detrimental effects. I was pointing out this false statement
... that means that the placebo is all vaccine constituents minus the antigens.
Yes we are beating a dead horse but
Gardasil is a sterile suspension, with each 0.5mL dose containing approximately 20 mcg of HPV 6 L1 protein, 40 mcg of HPV 11 L1 protein, 40 mcg of HPV 16 L1 protein, and 20 mcg of HPV 18 L1 protein, 225 mcg of aluminum (as Amorphous Aluminum Hydroxyphosphate Sulfate (AAHS) adjuvant), 9.56 mg of sodium chloride, 0.78 mg of L-histidine, 50 mcg of polysorbate 80, 35 mcg of sodium borate, < 7 mcg yeast protein/dose, and water for injection. The product does not contain a preservative or antibiotics.
---------------------------------
The placebo was normal saline with adjuvant; each 0.5mL dose of placebo contained 225 mcg of AAHS adjuvant, the same amount contained in each dose of Gardasil
No mention of these [sodium chloride, L-histidine, polysorbate 80, sodium borate, and/or yeast protein?] in the placebo
As to the placebo question itself, there's little more to be said than we interpret the meaning of âplaceboâ differently
We're beating a dead horse only because you seem to be conflating two issues.
Clinical trials:
*test vaccine = AAHS + antigens
*control placebo vaccine = AAHS only
Do you agree that the above is an accurate simplification of the clinical trial presented above? Do you agree that this is a valid placebo control for the study?
Assuming you'll answer yes, because you're not actually an idiot, then you must agree that in the clinical trials the placebo can be accurately described as test vaccine constituents minus the antigens.
Moving on...The current vaccine uses the components found in the test vaccine plus the additional ingredients listed above.
One could argue that the present vaccine hasn't had a sodium chloride, L-histidine, polysorbate 80, sodium borate, and yeast protein-only placebo control to compare against. Whether that is true I cannot say at this time. If so, it's a technically valid argument. However, its relevance is limited unless there is any reason to expect that these rather common ingredients should affect the safety & efficacy of the vaccine.
If you have a beef with sodium chloride, L-histidine, polysorbate 80, sodium borate, or yeast protein as a vaccine ingredient, your present argument is an awfully convoluted attempt to make such a case.
So you cannot demonstrate that they weren't present. You made the claim that they definitely weren't, remember?
There are numerous kinds of placebos, just because you vapidly object to the use of this one, doesn't mean that it isn't an acceptable placebo.
May I ask what Gardisil has to do with pertussis, Hib or measles? Did its introduction somehow contribute to the increase of pertussis and Hib?
Orac: "Jake Crosby specializes in scraping the bottom of the barrel."
Actually, no.
He specialises in diverting faecal matter from his sigmoid colon to his larynx for oral dispersion.
Technically valid, but, in my opinion, comparing a vaccine with another vaccine, as was the case with PCV-9, or with an isolated adjuvant distorts the generally accepted meaning of the word placebo and creates a distorted impression of safety
The MMR has been used since 1971. The DTaP has been used in Japan since 1981, and in the USA since the early 1990s. And the Hib has been used for almost twenty years.
Can you please point to the evidence that these vaccines are more dangerous than the diseases that Dr. Snyderman discussed (and failed to discuss in the case of Hib instead of measles) because they are returning?
I briefly flipped through Snyderman's book at Barnes and Noble and noted a chapter on integrative medicine and how it's the wave of the future. I'm sure it's much more difficult fact checking on live tv, but she doesn't strike me as the brightest. Maybe it's tv doctors in general.
I'm not a Snyderman fan or anything, but I have to add to her defense. It's hard enough making technical things clear to lay readers in print. (Try explaining physics without using math sometime, for example.) It's even harder to explain things clearly and cogently on TV or radio, and get it right the first time. She goofed, for sure, but in the grand scheme of things her overall message that "vaccinations are good, childhood illnesses are bad" got through to John Q. and Jane Z. Public.
@Sid Offit:
What, are you saying that Dr. Snyderman is hysterical? (In the non-humor sense) That's the only sense I can make out of your sentence.
That's certainly how I read it. It doesn't help that there are a LOT of alties out there with a misogynist streak.
Either that, or there's a natural correlation between deliberate trolldom and misogyny.
Probably a bit of both going on at once, I imagine.
It's fascinating to be the subject of the latest round of abuse from the hatesite Age of Autism. I don't know about you, but I could hear the grunting of hogs wallowing in their own shit.
The filth that swirls around Dan Olmsted and David Kirby is of an order I've never seen associated with journalists. I guess they've long ceased to smell themselves. But I think, reading some of the posts of their most devoted followers, they know what they've become. I try to feel compassion, but really I pity the pair of them.
But as for the form of the abuse, well that's interesting. On one of around 600 pages on my site I have some personal pages, one of which has a series of mugshots taken at various times since I first sat up as a baby. It's not Antony Gormley's 31 lifesize statues of himself set up on Crosby Beach near Liverpool, nor Tracey Emin's bed, now in the Saatchi collection, but it's a little expression of myself for people who might want to know more about me.
I'm not at all surprised that it should set off the chorus of foul abuse - some of it too filthy even for Age of Autism to leave in place for more than a day or so at a time - that it did. As others have noted, there's no rational basis for what they say, but there is an identifable cause: fear.
What they fear is what the page is meant to do. And indeed what it has done for some years. It invites people to get some sense of who I am: like a movie, not a still image. Me, my life. A person. Not just a by-line, a news report or a TV show. And I can't tell you, over the last few years, how positively people have responded to my website, including specifically that page.
Like another feature I recently uploaded - a half hour interview I did for Radio New Zealand - it helps to reveal the person behind the investigation which removed Wakefield from medicine and science. And the person it reveals leaves them in a state of incandescent impotency.
These people bring no interest in autism, vaccines, children's safety or anything to the table but their festering hatred. Hatred desperately searching for somewhere to attach before it turns back again on themselves.
BTW: towards the bottom right of this page is the Radio New Zealand piece which tells of how Wakefield got nailed. If you heard it, you'll really be able to imagine how much Age of Autism hate me:
http://briandeer.com/mmr/lancet-summary.htm
I guess Sid's "point" is if you test a vaccine against its adjuvant mixture placebo you're hiding the "safety risk" of the adjuvant mixture (all that aluminum). Why he doesn't straight as for a second control group just being given straight saline solution isn't clear so, probably because he doesn't like saline either.
Someone will, I trust, correct me if I am wrong, but if memory serves when developing novel treatments or medications for something that already has an existing treatment/medication, one compares the novel to the existing and not to a placebo during trials, on account of it being unethical to deny people the current standard of care. Also, the new treatment is supposed to be better than the existing treatment - if it isn't, what do we care if it's better than placebo or not?
Is that correct?
That being the case, if PCV-9 was developed as a vaccine for something that has a vaccine already (I note, for example, that PCV-7 is the one in use in Canada where I live) it would be unethical to compare PCV-9 vaccination to placebo because that would deny people the standard of care.
@Composer99
Generally, you're right. If a novel product (drug or device) is being developed, it should be tested against the "gold standard" approved product. So, if PCV-7 is approved in the U.S., and it is the current gold standard, then the clinical trials should test the new product against PCV-7. There are two ways the maker can test the new product: try to show that the new product is better than PCV-7, or try to show that the new product is no worse than PCV-7.
Now, the definition of "better than" can be several different things. It could, for instance, mean that although the product is less effective, it has a significantly better safety profile.
Also, depending on the indication being targeted, it may be justifiable to use a placebo. However, the more serious the disease or condition, the less ethical it is to use placebo. If there are no approved products for the indication, then a placebo could be used, even for serious conditions. Depending on the severity and risks involved, there may, however, be a DSMB performing periodic checks to see if a) the new product is causing unacceptable risks to subjects or b) if the new product is so overwhelmingly positive that to continue the trial would be unethical to the control group(s).
@67
for testing efficacy, yes. For testing safety, no.
(as I understand it)
Somewhat OT,but I think I found something ORAC,and his readers would find very interesting.
Much has been written,in the past couple of years,about SHANK3 and autism.Even ORAC has gotten into the act.
http://scienceblogs.com/insolence/2010/06/more_evidence_for_a_genetic_b…
Yet,nowhere in all the bytes spilled into the interwebs,did I ever see anybody talk about the connection made by French researchers,between SHANK3,autism,and chromosome 22q13 deletion.It's there.
http://www.touchneurology.com/files/article_pdfs/durand%5B1%5D.pdf
I think this study is every it as important as the one linking autism and mitochondrial disease a few years ago,and not because I have both an autism diagnosis,and a 22q13 deletion myself.
Chris: "Can you please point to the evidence that these vaccines are more dangerous than the diseases that Dr. Snyderman discussed (and failed to discuss in the case of Hib instead of measles) because they are returning?"
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Pertussis vaccine in use in late 40's. I don't have the pre-1940 stats available at this moment so I'll use 1950 as a start.
http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/G/cases&…
1950: 150 million people (U.S census). 120,000 pertussis cases. 1100 deaths
% of population getting pertussis: 8/100 of one percent.
Percent of population deaths from pertussis: 0.0007%
For >99% of the population did not need a pertussis vaccine. For them the risk of death or permanent damage from the vaccine outweighs the unnecessary benefit whatever perceived benefit that is.
Percent of the population recommended to get pertussis vaccine: ~100%
http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/tetanus.pdf
"The Institute of Medicine has concluded that the available evidence favors a causal relationship between tetanus toxoid and both brachial neuritis and GBS, although these reactions are very rare."
For someone who was NEVER going to get whooping cough or die from it, it sucks to get a neurogical disease as a trade off.
http://www.healthsentinel.com/joomla/images/stories/graphs/us-pertussis…
Why don't we use the whole cell pertussis vaccine again?
Little Augie... that did not answer my question, it must be due to some kind of reading disability. Did you notice understand what the word "rare" means?
What is the evidence that the DTaP is more dangerous than pertussis?
(and the HealthSentinal website qualifies as a Scopie's Law site)
Plus, a 7th infant has died in California due to pertussis. So, exactly how many people have died from the DTaP vaccine?
I can't get the video to play on my Ubuntu, so I can't listen to what was actually said; all I have was the transcript you supplied, but from that, you appear to be jumping on her for speaking loosely rather than actually saying something which isn't true.
She said (according to the transcript above, which may or may not reflect her actual phrasing: "Last year in Minnesota and in Philadelphia we know children died of measles."
She didn't say, "Last year in Minnesota and in Philadelphia we know children died of measles also last year."
Has it occurred to you that she may have simply meant that deaths had occurred and spoken so loosely that one interpretation of what she said was that it was last year?
IanW, the children died of Hib, not measles!
Little Augie, care to explain exactly what the dangers are of the DTaP vaccine?
I just finished reading Inside the Outbreaks. It really wasn't until the subject of that book started in 1951 that disease statistics were regularly gathered. Plus, vaccines were not given as routine since they were expensive. The use of vaccines became for common after the experience with polio.
Now some more data from that Appendix G:
This is for pertussis:
Year___Cases__Deaths__Year___Cases__Deaths
2000____7867____ 12___1950__120718__1118
2001____7580____ 17___1951___68687___951
2002____9771____ 18___1952___45030___402
2003___11647____ 11___1953___37129___270
2004___25827____ 16___1954___60886___373
2005___25616____ 31___1955___62786___467
2006___15632____ NA___1956___31732___266
Total_103940____140_________426968__3847
Why do you find that number of deaths acceptable? Now, do you see how the number of cases is increasing? Why do you think you would not get the disease?
Now for tetanus:
Year__Cases__Deaths__Year___Cases___Deaths
2000_____35____ 5____1950____486____336
2001_____37____ 5____1951____506____394
2002_____25____ 5____1952____484____360
2003_____20____ 4____1953____506____337
2004_____34____ 4____1954____524____332
2005_____27____ 1____1955____462____265
2006_____41____ NA___1956____468____246
Total___219____19 or more___3436___2270
Here is the interesting thing, there is no herd immunity from tetanus. The fun thing is that your reference with the word "rare" also said that folks who get the vaccine don't really tetanus. Tetanus occurs to those who don't get the vaccine. So the numbers above are low because most of the population does get their tetanus boosters. So what makes you think you are immune to a pathogen that is everywhere?
Here is another couple of quotes from that document:
Again, what makes you think you are immune to tetanus?
So tell us again, exactly what evidence do you have that the DTaP vaccine is more dangerous than pertussis?
Augustine, I'm sorry that we have failed to improve your skills at looking at data.
So you are using data from a population after the widespread introduction of the vaccine. This is not a "start". It makes the data useless for your argument.
Have you really not picked up the difference between incidence and prevalence in the last few months? It would be much more relevant to compare the deaths to the live birth rate (in the pre-vaccine period, of course).
It's complex stuff, and I can understand how confusing it might be. What I don't understand is how you justify calling Rene unscientific.
Again, only in that given year, because you are using incidence rates. Still, it's a "no duh" that the overwhelming majority of the population will not be saved from death or disability by the vaccine. You argue this alot, but (as has been taught to you many times) it is only valid if we knew which children were going to die and selectively vaccinate them.
Since there is no way to know this, the fact remains that the chance of a side effect is incredibly small compared to the chance of death or disability from the disease. Most people will not be saved from death or disability, but they will have a reduced chance of death or disability, as well as suffering. This has been explained many times. I'm hoping it will start to sink in eventually.
Anyway, the question was asked of Sid. If you're having trouble with the concepts above, you should probably leave the answering to Sid's razor-sharp scientific mind.
Chris: "Plus, a 7th infant has died in California due to pertussis. So, exactly how many people have died from the DTaP vaccine?"
To someone who will NEVER get whooping cough the question is irrelevant. And that is >99% of the population. Prevaccine.
Orange Lantern: "Most people will not be saved from death or disability, but they will have a reduced chance of death or disability, as well as suffering."
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The logic used here is DUMBFOUNDING! Utterly as unscientific and logically insane as it gets.
Your professors of ideology have either truly confused you or thoroughly indoctrinated you. I vote the latter.
I'll keep your logic in mind next time I play the lottery. I may not win but at least I increased my chances. Genius. Compared to going broke.
Maybe you could have a conversation with Chris and get on the same page with her. She's arguing that vaccines weren't in widespread use at that time.
You need to continue your conversation with passiondron. Maybe you could learn more than just dogma.
Little Augie:
How do you know that? When you become an adult sometime in the next couple of decades, pertussis will manifest itself as a very bad cold. Then you will inadvertently and stupidly infect someone who cannot deal with it, like an infant. And a reminder, that tetanus is everywhere.
Your idiotic refusal to answer the question is a testament to your general dishonesty. The fact that pertussis is increasing, and real children are actually dying makes your premise that you will not get it incredibly stupid.
Try again: What evidence do you have that the DTaP is more dangerous than pertussis?
Why do you not care about babies? Are they irrelevant to your mindset? Something about them not being real humans until they past a certain age, a common way to deal with high childhood mortality before vaccines and sanitation. I know you will not read this very painful description of the death of an infant from pertussis.
You go on about "prevaccine" with some hand waving that vaccines did not do anything. Here is some actual data on the rates of death/100000 in 1950 and 2006 of certain age groups from http://www.cdc.gov/nchs/data/hus/hus09.pdf#031:
.............1950.......2006
Under 1 year.3,299.2____690.7
1â4 years .....139.4_____28.4
Would you care to explain why the change? Remember there were real sewer systems and clean water in the 1950s.
While you are at it, would you care to explain what happened between 1960 and 1970 in this other census data?
From http://www.census.gov/prod/99pubs/99statab/sec31.pdf
Year.... Rate per 100000 of measles
1912 . . . 310.0
1920 . . . 480.5
1925 . . . 194.3
1930 . . . 340.8
1935 . . . 584.6
1940 . . . 220.7
1945 . . . 110.2
1950 . . . 210.1
1955 . . . 337.9
1960 . . . 245.4
1965 . . . 135.1
1970 . . . . 23.2
1975 . . . . 11.3
1980 . . . . . 5.9
1985 . . . . . 1.2
1990 . . . . .11.2
1991 . . . . . .3.8
1992 . . . . . .0.9
1993 . . . . . .0.1
1994 . . . . . .0.4
1995 . . . . . .0.1
1996 . . . . . .0.2
1997 . . . . . . 0.1
Nothing like the "That's the stupidest thing I've ever heard for reasons that I not going to tell you about" defense.
PassionlessDrone, despite our disagreements, understands this material much better than you do.
I think you're right. It is apparent that you have been dumbfounded.
@Matt Cline
What, are you saying that Dr. Snyderman is hysterical? (In the non-humor sense) That's the only sense I can make out of your sentence.
----------------
If the straight jacket fits.......
Translated: "You should only prepare for the unexpected if you already know for a fact that it's going to happen."
Seriously, is augie just a Poe? Surely no one can be that dense!
Antaeus Feldspar: "Seriously, is augie just a Poe? Surely no one can be that dense!"
What's a Poe?
@augestine:
I'm curious, in your opinion, has there ever been any vaccine ever, at any point in time, where the risk/benefit ratio was worth taking it?
Also, if I recall correctly, you made some reference to the futility of modern medicine's war against microbes (or something similar), so what's your opinion on antibiotics?
Mathew Cline: "I'm curious, in your opinion, has there ever been any vaccine ever, at any point in time, where the risk/benefit ratio was worth taking it?"
I'm curious too. Has there ever been a vaccine approved by the ACIP and CDC that SBMers would dissapprove of or say "hold on a minute here?"
And for your question, are you asking for me personally or people in general?
augustine said:
augustine justifies this claim using this stat...
1950: 150 million people (U.S census). 120,000 pertussis cases. 1100 deaths
Ignoring that these are not actually prevaccine data and that augustine has provided other evidence above that the prevaccine incidence and death rate for pertussis were substantially higher, let's examine the claim that greater than 99% of the population will not get pertussis.
Rounding off numbers to make the math simpler, in 1950 ~0.1% of the population had a diagnosed pertussis infection and ~1% of those cases were fatal. Even though it's a flawed simplification, let's pretend that these would be steady annual proportion values in the absence of a vaccine and that the proportion of those who get more than one lifetime pertussis infection in effectively zero.
Here's the approximate lifetime risk of having a a diagnosed pertussis infection:
risk = [1-.001]^age
By age 1: 0.1%
By age 5: 0.5%
By age 10: 1.0%
By age 25: 2.5%
By age 50: 4.9%
By age 75: 7.2%
(Fatality estimates would be 1/100 of the above values)
While it is true that the symptoms of pertussis infection are generally far more benign as an adult, it's also highly contagious. Pertussis occurs at much higher local incidences due to its epidemiological properties, and infant infection (the highest-risk group) if often attributed to exposure from parents or other family with low-grade infection.
Clearly the above relies upon several simplifications, but it is an illustrative exercise that may prove informative to those that can be confused by the handwaving of those who deal in subterfuges.
As usual, you completely avoided answering Matt's question. I am a proponent of SBM and I 'disapprove' of some ACIP/CDC vaccine recommendations. Now answer the damn question.
SM: "I am a proponent of SBM and I 'disapprove' of some ACIP/CDC vaccine recommendations."
So do you disapprove because they (ACIP) lack evidence or science?
scientizzle: (Fatality estimates would be 1/100 of the above values)
----------------------------------------------------
No they wouldn't. 80% of pertussis deaths are under 6 mos. with the majority of those in the under 3 mos.
You would have to see the actual numbers in each age group to get the actual estimated case fatality. It would not be the same for someone over 6 mos.
"Pertussis occurs at much higher local incidences due to its epidemiological properties, and infant infection (the highest-risk group) if often attributed to exposure from parents or other family with low-grade infection."
You have very little to worry about if your neighbor is NOT vaccinated. Except the vaccine may only work in 60% of the population.
foshizzle mynizzle scientizzle.
@augustine:
I'm asking you, personally.
@83
For me personally and my immediate family, there is NO vaccine worth taking. I have confidence in my body. And statistically speaking, from an evidence POV, I have good reason to be confident. Not that it matters.
Antibiotics can save a persons life.
If used in a prophylactic manner, they fall into the same category as vaccines.
I have a problem with prophetic medical practice.
@augustine:
I think I might have misunderstood your "you personally vs people in general" request for clarification, so, to clarify my question, an example sub-question, to demonstrate the point I was getting at:
From the time the smallpox vaccine was first invented, to the time that smallpox was eliminated from the wild, did there exist any person for whom the risk/benefit ratio of the vaccine made it worth taking, for that person, in your opinion?
@augustine:
Also, if, in your opinion, there ever existed anyone for whom there was any vaccine where the risk/benefit ratio was worth it, could you please go into a little detail, rather than just saying "yes, such people existed"?
@augustine:
Okay, that seems to go beyond saying that the risk/benefit ratio of vaccines isn't worth it for you or your immediate family. For example, consider someone (lets call him John Doe) who lived back when the smallpox vaccine was first invented, and he was considering whether or not to get vaccinated. Regardless of the risk/benefit ratio of John Doe taking the vaccine, it's not guaranteed that he'll ever catch smallpox, and even if he does catch it there's a 70% chance he'll survive. So him taking it would have been a "prophetic medical practice".
Anyways, I don't see why you'd call it "prophetic" medicine. John Doe wouldn't be taking it because he can see into the future and knows he'll die of smallpox if he doesn't get vaccinated, but is taking it to reduce the risk of dying of smallpox. I don't see how reducing the risk of something that might happen in the future as being "prophetic". Indeed, calling it "prophetic" seems to imply that there's something flawed in the concept of risk/benefit analysis.
Well, geez now there augustine. Didn't I point out everything you "corrected" me on in comment 88?
One of the important parts of my illustration was to demonstrate how your reliance on a claim that "[greater than] 99% of the population...will NEVER get whooping cough" as part of your "argument" was demonstrably wrong. Did you get that part? Do you see how it's demonstrably wrong?
@augestine:
What about if you or a family member was bitten by a rabid dog, would it be worth taking the rabies vaccine then?
One wonders how augustine feels about playing Russian Roulette. After all, odds are you won't die so it's perfectly safe, right?
Even a small chance of death or permanent disability is very worth preventing if the preventive measure carries a much smaller risk - to anybody sane.
According to augie's logic, he/she/it must not have any insurance of any kind, either.
What augie is saying is that he "believes" that there is no (or extremely limited) risk of contracting any of these diseases, so the vaccines are unnecessary.
Of course, this does ignore the fact that it has been the mass utilization of vaccines that has made this choice possible (however inadvisable that this might be).
I also believe that he wants 100% assurance that he (or his family) will get a disease, before taking any sort of pro-active measures. While it is easy to say - well, I'm healthy, my body can take care of it - what happens when you receive that diagnosis of cancer?
I know that the response will be - well, that's a strawman argument, because I don't have cancer & don't deal with hypotheticals.
I would love for augie to very concisely spell out his personal philosophy & how he intends to maintain his health outside of SBM.
I was screaming at the TV while watching Synderman. It really irks me when "mis-information" and/or "incomplete information" is spread regarding VPDs. The current increase in cases of pertussis across the US are not solely caused by unvaccinated children. The increase is due to it being a peak year for pertussis (i.e cyclical disease) and because most everyone in the US over the age of 15 has no immunity left from the vaccine (the use of the Tdap is really low). Oh, and the fact that most pertussis cases are in adults and go undiagnosed. Snyderman had the perfect opportunity to encourage adults to go and get the Tdap but instead chose to blame unvaccinated children. Way to go, Nancy.
It's nice that with the right questions we can get auggie to say something a little more crankish in each subsequent thread. Is somebody compiling a "best of" by any chance? What a doofus.
It also ignores the fact that rational risk management considers not only the chance of an outcome happening, but also the severity of that outcome. A 50% chance of a headache is a much smaller risk than a 1% chance of death, even though 1% << 50%.
"A 50% chance of a headache is a much smaller risk than a 1% chance of death, even though 1%"
How about trying to quantify that for us, Scott. And does that quantification change to say a headache sufferer who wants to commit suicide?
In SBMers rational world I guess 50<1.
I know what you're trying to say but don't act like you have some hard calculation on it. You can't accurately quantify what you're trying to say. Subjective values are involved.
Scott: "One wonders how augustine feels about playing Russian Roulette. After all, odds are you won't die so it's perfectly safe, right?"
Russian roulette is a closed system. 6 chambers. 1 bullet. You're definitely going to pull the trigger. You can calculate an individual's odds of survival.
Trying to get an accurate estimate on a single individual when it comes to disease prediction and vaccine safety is near impossible. As far as we know it's an open system.
EXACTLY! And why would you still refuse vaccination (if naught else, in order to protect teh innocent babbies) unless you had 100% certainty that you personally would actually contract $infectious_disease hmmmm?
Maybe a sustained experiment with the Snubnose Saturday Special is what it would take to educate owgustine. Rinse, repeat etc until done. THEN come back and report, please.
Rrr- another fine example of an SBMer. Lot's of emotion. Not much in critical thinking. Not a scientist.
Ahhhhh, so Augustine is choosing to argue about probability? A very, very unwise move. Augustine is, after all, the one who said:
As was pointed out at the time, this is a failure of logic equivalent to "If a person claims that a fair coin has a 50% chance of coming up heads the next time it's flipped, he's wrong, because it's either a 100% chance that it's heads or a 0% chance." (It wasn't Augie's first probability fumble, either.)
It seems to me that if Augustine is going to make any argument that depends upon probability, he needs to show that he understands probability. So, Augustine:
Q.1) When a fair coin is flipped, what is the probability expressed as a percentage chance that it will come up heads?
Q.2a) If the coin comes up heads, does that mean it was "100% wrong" to give the answer you just gave to Q.1?
Q.2b) If the coin comes up heads, does that mean it was "100% wrong" to give the answer you just gave to Q.1?
Q.3) How can the correct answers to Q.1, Q.2a, and Q.2b be reconciled with your claim that "If the meteorologist claims an 80% chance of rain and it doesn't he's not wrong 20% of the time. He's 100% wrong!"? (Hint: the correct answer is two words and rhymes with "cay than't.")
Q.4) Are you going to acknowledge your error, as you once claimed you would do, or are you going to prove yourself mendacious and hypocritical?
Answer soon, Augie.